Fustat: In planes, malls, and sometimes even automobiles, I feel like I can't breathe, get dizzy, and have trouble swallowing. It is very difficult to live like this. Is there help? I have found that exercising has helped a lot, but I still don't feel like I used to.

This is a typical anxiety reaction that stems from your mind mistakenly interpreting that you are in danger. Anxiety is a normal and self-protective signal that we experience when there is an external danger, like crossing a busy street full of onrushing traffic. However, sometimes our anxiety signal goes off when there is no external danger, sort of like a smoke detector beeping when there is no smoke. When this happens, we call it an anxiety disorder.

Most likely, it starts with some idea or thought outside of conscious awareness that makes us afraid. Perhaps you feel that you may need to rapidly flee from an enclosed space such as an airplane and fear that you won't have an exit when you need it. This "no exit" feeling begins to preoccupy your thoughts. The more you tell yourself that there is no way out, the more you fear that you will be compelled to flee. Adrenaline — the fight or flight hormone — starts flowing, which in turn increases your heart and breathing rates so that you can get more freshly oxygenated blood to your brain cells and muscles. Your pupils dilate. If your breathing becomes so rapid that you are in fact hyperventilating, you blow off too much carbon dioxide from your lungs, and your lips and fingertips start to tingle. Dizziness sets in. At this point, the best immediate treatment is to breath into a paper bag, restoring the normal carbon dioxide levels to your blood.

After the acute anxiety attack has subsided, it would be very helpful to talk with a psychotherapist so that you develop some understanding of exactly what you fear in enclosed spaces. Some people fear that they will lose control of their bodily functions and humiliate themselves by making a mess. These people are deeply fearful about losing control, and this fear cements in a claustrophobic idea (for instance, "If I am trapped in an enclosed space, I will not be able to get out to go to the toilet when I need to.") Panic ensues.

Some mild anti-anxiety agents such as Xanax (alprazolam), Ativan (lorazepam), Klonapin (clonazepam) or BuSpar (buspirone) that can be prescribed by a psychiatrist may be a helpful adjunct to psychotherapy in relieving your anxiety symptoms.